Perineum

Question 1

prolapse of pelvic viscera

Answer 1

due to stretching or tearing of attachments of perineal muscles

• prolapse of bladder through urethra
• prolapse of vagina/uterus through vaginal orifice

Question 2

cystocele, rectocele, enterocele

Answer 2

herniations of part of bladder, rectum, or rectovaginal pouch, respectively, into vaginal wall

Question 3

diastasis

Answer 3

separation

Question 4

episiotomy

Answer 4

surgical incision of the perineum and inferoposterior vaginal wall - may be made to enlarge vaginal orifice to decrease trauma of childbirth

Question 5

what is major structure incised during median episiotomy?

Answer 5

perineal body - but further tearing goes toward anus and there is risk of sphincter damage

Question 6

what type of episiotomy is preferred to median episiotomy and why?

Answer 6

mediolateral -less incidence of severe laceration, less likely to damage anal sphincters/canal

Question 7

rupture of intermediate part of urethra

Answer 7

• can be caused by fractures of pelvic girdle

- causes escape of urine and blood into deep perineal pouch

Question 8

common site of rupture of the spongy urethra and extravasation of urine

Answer 8

bulb of the penis - from straddle injury or false passage of instrument

Question 9

what determines the direction of flow of the extravasated urine?

Answer 9

attachments of perineal fascia

Question 10

what is among the last fat reserves to be used up in starvation? what can loss of this lead to?

Answer 10

fat in the ischio-anal fossa - leads to rectal prolapse

Question 11

pectinate line

Answer 11

dentate/mucocutaneous line - approximates level of important anatomical changes related to transition from visceral to parietal

Question 12

ischio-anal abscesses

Answer 12

collections of pus in ischio-anal fossa

Question 13

how can infection reach the ischio-anal fossa?

Answer 13

• after cryptitis
• extension from a pelvirectal abscess
• after a tear in the anal mucous membrane
• from a penetrating wound in the anal region

Question 14

cryptitis

Answer 14

inflammation of anal sinuses

Question 15

how can an abscess in one ischio-anal fossa spread to the other?

Answer 15

through the deep post-anal space

Question 16

anal fissure

Answer 16

slit-like lesion usually in the posterior midline, inferior to the anal valves

Question 17

what can infection of an anal fissure lead to?

Answer 17

peri-anal abscess

Question 18

anal fistula cause

Answer 18

spread of an anal infection and cryptitis

Question 19

anal fistula

Answer 19

connects anal canal to abscess in the ischio-anal fossa or into the peri-anal skin

Question 20

internal hemorrhoids

Answer 20

prolapses of rectal mucosa containing normally dilated veins of internal rectal venous plexus

Question 21

bleeding of internal hemorrhoids

Answer 21

characteristically bright red due to many arteriovenous anastamoses

Question 22

treatment of internal hemorrhoids

Answer 22

only done if they are prolapsed and ulcerated

Question 23

external hemorrhoids

Answer 23

thromboses in the veins of the external rectal venous plexus covered by skin

Question 24

in portal hypertension related to hepatic cirrhosis, what veins may become varicose?

Answer 24

portocaval anastamoses b/w the superior, middle, and inferior rectal veins

Question 25

when do internal hemorrhoids most commonly occur?

Answer 25

absence of portal hypertension - veins of rectal plexuses normally look varicose

Question 26

what can cause pudendal nerve damage and anorectal incontinence?

Answer 26

stretching of the pudendal nerve(s) during traumatic childbirth